The importance of leg length discrepancy after total hip arthroplasty.
01 Feb 2005-Journal of Bone and Joint Surgery-british Volume (The British Editorial Society of Bone and Joint Surgery)-Vol. 87, Iss: 2, pp 155-157
TL;DR: Assessment of leg length discrepancy and hip function in 90 patients undergoing primary total hip arthroplasty before surgery and at three and 12 months after found Appropriate placement of the femoral component could significantly reduce a patient's perception of discrepancy of length.
Abstract: We assessed leg length discrepancy and hip function in 90 patients undergoing primary total hip arthroplasty before surgery and at three and 12 months after. Function was measured using the Oxford hip score (OHS). After surgery the mean OHS improved by 26 points after three months and by 30 points after 12. After operation 56 (62%) limbs were long by a mean of 9 mm and this was perceived by 24 (43%) patients after three months and by 18 (33%) after 12. The mean OHS in patients who perceived true lengthening was 27% worse than the rest of the population after three months and 18% worse after 12. In 55 (98%) patients, lengthening occurred in the femoral component. Appropriate placement of the femoral component could significantly reduce a patient's perception of discrepancy of length.
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Patent•
24 Jul 2009
TL;DR: In this paper, a surgical orientation device and orthopedic fixtures can be used to locate the orientation of an axis in the body, adjust an orientation of a cutting plane or planes along a bony surface, to distract a joint, or to assist in an Orthopedic procedure or procedures.
Abstract: Systems and methods for joint replacement are provided. The systems and methods include a surgical orientation device and at least one orthopedic fixture. The surgical orientation device and orthopedic fixtures can be used to locate the orientation of an axis in the body, to adjust an orientation of a cutting plane or planes along a bony surface, to distract a joint, or to otherwise assist in an orthopedic procedure or procedures.
680 citations
TL;DR: The enhanced stability afforded by the use of a large-diameter femoral head avoided over-lengthening of the limb or increased offset to improve soft-tissue tension as occurs sometimes in THA.
Abstract: We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; -2.8 to 11.6) and decreased with SRA (mean -3.3 mm; -8.9 to 8.2). Femoral offset was restored within sd 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p < 0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (-6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (-7.1 to +2.05) in the SRA group, compared with the contralateral side. Leg-length inequality was restored within sd 4 mm in 42 (86%) of the SRA and 33 (60%) of the THA patients. The radiological parameters of acetabular reconstruction were similar in both groups. Restoration of the normal proximal femoral anatomy was more precise with SRA. The enhanced stability afforded by the use of a large-diameter femoral head avoided over-lengthening of the limb or increased offset to improve soft-tissue tension as occurs sometimes in THA. In a subgroup of patients with significant pre-operative deformity, restoration of the normal hip anatomy with lower pre-operative femoral offset or significant shortening of the leg was still possible with SRA.
241 citations
Patent•
10 Sep 2009
TL;DR: Orthopedic systems and methods for use in preparing joints for implants are provided in this paper, which can be used to orient the hip during the procedure, determine the orientation of an anatomical plane or planes, and orient a prosthetic component or components.
Abstract: Orthopedic systems and methods are provided for use in preparing joints for implants. Specifically, hip preparation systems and methods are disclosed which can include a surgical orientation device. The hip preparation systems and methods can be used, for example, to orient the hip during the procedure, determine the orientation of an anatomical plane or planes, and orient a prosthetic component or components.
191 citations
TL;DR: Definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account and when symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration.
Abstract: Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration.
149 citations
TL;DR: The data show use of the biischial line as a pelvic reference should be discouraged and the interteardrop line is a better alternative, and the center of the femoral head is a more reliable femoral landmark compared with the lesser trochanter.
Abstract: Background
Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used.
148 citations
Cites background from "The importance of leg length discre..."
...One study [53] in the orthopaedic literature suggests a LLD has no effect on the functional outcome of THA, but many surgeons perceive it as an important problem to avoid [6, 12, 22, 24, 29, 58]....
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References
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TL;DR: In this article, a 12-item questionnaire for patients having a total knee replacement (TKR) was developed and a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36.
Abstract: We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36. Some also filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon completed the American Knee Society (AKS) clinical score. The single score derived from the new questionnaire had high internal consistency, and its reproducibility, examined by test-retest reliability, was found to be satisfactory. Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. We also compared change in scores with the patients' retrospective judgement of change in their condition. The effect size for the new questionnaire compared favourably with those for the relevant parts of the SF36. The change scores for the new knee questionnaire were significantly greater (p < 0.0001) for patients who reported the most improvement in their condition. The new questionnaire provides a measure of outcome for TKR that is short, practical, reliable, valid and sensitive to clinically important changes over time.
2,177 citations
TL;DR: During the ten-year period ending in 1978, 10,500 conventional total hip arthroplasties were performed at the Mayo Clinic; dislocation developed after 331 of these procedures; cross correlations of the data were performed and showed that previous surgery on the hip was the most significant of the factors predisposing to dislocation.
Abstract: During the ten-year period ending in 1978, 10,500 conventional total hip arthroplasties were performed at the Mayo Clinic; dislocation developed after 331 (3.2 per cent) of these procedures. Cross correlations of the data were performed using multivariate analysis. This analysis showed that previous surgery on the hip was the most significant of the factors predisposing to dislocation, the incidence doubling from 2.4 per cent (in hips without previous surgery) to 4.8 per cent (in hips with previous surgery) (p less than 0.001). The dislocation rate was 2.3 per cent after an anterolateral approach and 5.8 per cent after a posterior approach (p less than 0.01). The size of the head of the femoral component was not a strongly influential factor. The incidence of dislocation was 17.6 per cent in the hips that had osteotomy and avulsion of the greater trochanter, compared with 2.8 per cent in those in which the trochanteric osteotomy united (p less than 0.001). Reoperation for instability of the hip was performed in a third of the patients, but in 31 per cent of the patients whose hip was reoperated on the instability persisted after the revision.
1,115 citations
TL;DR: In the majority of cases, the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity, and when correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved.
Abstract: A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low-back and/or unilateral hip symptoms and 359 symptom free subjects. Statistically highly significant correlations of the symptoms and leg length inequality were observed. In the majority (79 and 89%), the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity. When correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved in the majority of the cases. The unilateral symptoms associated with mostly unrecognized leg length inequality of 5 to 25 mm were, at least in part, due to the biomechanical responses, like bending and rotational forces, needed for compensation of the lateral imbalance caused by leg length inequality.
369 citations
319 citations
TL;DR: In this paper, the authors investigated whether there is a demonstrable relationship between discrepancy in leg length after total hip replacement and post-operative functional outcomes and patient satisfaction, and found no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction.
Abstract: Discrepancy in leg length after total hip replacement has been associated with patient dissatisfaction. We prospectively studied 200 consecutive patients undergoing unilateral Charnley hip replacements to identify whether there is a demonstrable association between such disparity and postoperative function. Radiological measurements between defined points on the pelvis and femur of the operated hip were compared with the same points on the contralateral joint. A lengthening index was derived and statistical analysis used to compare this with validated functional outcome scores (Harris hip score and the SF36 Health Survey) and patient satisfaction. Our results showed no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction.
251 citations